Browsing by Author "Mallick, Rizwana"

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    A cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students
    (BioMed Central, 2018-11-29) Mallick, Rizwana; Kathard, Harsha; Borhan, A. S M; Pillay, Mershen; Thabane, Lehana
    Abstract Background Classroom-based stuttering intervention addressing negative peer attitudes, perceptions, teasing and bullying of children who stutter (CWS) is required as part of holistic stuttering management because of its occurrence in primary school. This study was conducted in 2017, in 10 primary schools in the Western Cape, South Africa within lower (second and third) and higher (fourth and fifth) quintiles. Objectives The primary objective of this study was to determine treatment effect at six months after intervention of grade 7 participants (Classroom Communication Resource [CCR] intervention versus no CCR) using global Stuttering Resource Outcomes Measure (SROM) scores in school clusters. The secondary objective was to determine grade 7 participant treatment effect on the SROM subscales including Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine any difference in the primary outcome between schools between and across quintile clusters (lower and higher). Methods Once schools were stratified into lower and higher quintile (which are defined according to geographical location, fee per school and resources) subgroup clusters, schools were assigned randomly to control and intervention groups consisting of grade 7 participants who were typically aged ≥ 11 years. Teachers received 1 h of training before administering the single-dose CCR intervention over a 60–90-min session. The CCR intervention included a social story, role-play and discussion. All participants viewed a video of a CWS and stuttering was defined at baseline. The SROM measured peer attitudes at six months after intervention. Randomisation was stratified by quintile group using a 1:1 allocation ratio. Full blinding was not possible; however, the outcome assessor was partially blinded and the analyst was also blinded. Generalised estimating equations (GEE) was used assuming an exchangeable correlation structure to analyse the data adopting an intention-to-treat principle. Multiple imputation was used to handle missing data. Criterion for statistical significance was set at alpha = 0.05. Results Ten schools were randomly allocated to control (k = 5) and intervention groups (k = 5), with n = 223 participants allocated to intervention and n = 231 to control groups. A total of 454 participants completed the SROMs in control (n = 231) and intervention (n = 223) groups and were analysed at baseline and six months after intervention. There was no statistically significant difference on the global SROM score (mean difference − 0.11; 95% confidence interval [CI] − 1.56–1.34; p = 0.88). There were also no significant differences on SROM subscales: PSD (mean difference 1.04; 95% CI − 1.02–311; p = 0.32), SP (mean difference − 0.45; 95% CI − 1.22–0.26; p = 0.21) and VI (mean difference 0.05; 95% CI − 1.01–1.11; p = 0.93). Additionally, there was no significant subgroup effect on the global SROM score (lower versus higher quintile subgroups) (interaction p value = 0.52). No harms were noted or reported. Conclusion No statistically significant differences were noted. It is possible that the time frame was too short to note changes in peer attitudes and that further study is required to confirm the findings of this study. Trial registration Clinicaltrials.gov, NCT03111524 . Registered on 9 March 2017.
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    Repositioning speech language pathology practices: engaging with family and community narratives to evolve communication supports for neurodivergent children
    (2025) Parusnath, Prianka; Kathard, Harsha; Mallick, Rizwana; Gretschel, Pamela
    In South Africa and the Majority World, Speech-Language Therapy services are not easy to access. The profession with its medical model roots can be elitest, reductive and ineffective in areas where therapists are a finite resource. The purpose of this study was to engage with families and communities in order to evolve communication supports for neurodivergent children with the focus on community practice, inclusion and belonging. Additionally, story telling was used as the vehicle for learning. These stories were further explored in the context of South Africa with a specific focus on Disability in the Majority World, Inclusion and Belonging, Decolonisation within the framework of current practice and Practice Shifts (currently taking place and on the horizon). In order to do explore these concepts, narrative interviews were conducted with four families and two community members in order to learn about their experiences regarding inclusion and belonging. The families all have children who access alternative communication and the focus of the interviews were to gain insight into their journeys and experiences with Speech Language Therapy, communication and how this impacted their experiences in their community. After analysis of these interviews, the stories were shared at a workshop attended by various professionals (teachers, psychologists, speech therapists etc.) to explore the impact that stories have on therapeutic learning and practice shifts. The analysis occurred in two phases. First a narrative analysis was conducted for each family and community member post interview. Then an analysis of the narratives was conducted which culminated in themes being curated. Graphic Harvesting and Thematic Analysis were used to analyse the workshop discussion. The most significant finding and a common thread in every family narrative was the burden of communication that was placed on them when Speech Therapists practiced in traditional ways (i.e. in therapy rooms behind closed doors). Additionally, exclusion was also prominent theme that arose, firstly just because the child has a disability and then secondly because alternative communication was seen as so different and “other” that it was further isolating. There was a definite call from families for practice shift that supported them more holistically out in their community. The Invisible String is a conceptual framework that proposes the union of decolonised practice concepts with the intersectionality of the families we work with. The image is of a patchwork quilt, families on one side, decolonial practise on the other with Speech-Language Therapists being the guiding hand to the needle of communication. The thread that binds it all is community. It is an offering of reuniting and remaking and bringing humanity and community to the forefront of practice.
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    Repositioning speech language pathology practices: engaging with family and community narratives to evolve communication supports for neurodivergent children
    (2025) Parusnath, Prianka; Kathard, Harsha; Mallick, Rizwana; Gretschel, Pamela
    In South Africa and the Majority World, Speech-Language Therapy services are not easy to access. The profession with its medical model roots can be elitest, reductive and ineffective in areas where therapists are a finite resource. The purpose of this study was to engage with families and communities in order to evolve communication supports for neurodivergent children with the focus on community practice, inclusion and belonging. Additionally, story telling was used as the vehicle for learning. These stories were further explored in the context of South Africa with a specific focus on Disability in the Majority World, Inclusion and Belonging, Decolonisation within the framework of current practice and Practice Shifts (currently taking place and on the horizon). In order to do explore these concepts, narrative interviews were conducted with four families and two community members in order to learn about their experiences regarding inclusion and belonging. The families all have children who access alternative communication and the focus of the interviews were to gain insight into their journeys and experiences with Speech Language Therapy, communication and how this impacted their experiences in their community. After analysis of these interviews, the stories were shared at a workshop attended by various professionals (teachers, psychologists, speech therapists etc.) to explore the impact that stories have on therapeutic learning and practice shifts. The analysis occurred in two phases. First a narrative analysis was conducted for each family and community member post interview. Then an analysis of the narratives was conducted which culminated in themes being curated. Graphic Harvesting and Thematic Analysis were used to analyse the workshop discussion. The most significant finding and a common thread in every family narrative was the burden of communication that was placed on them when Speech Therapists practiced in traditional ways (i.e. in therapy rooms behind closed doors). Additionally, exclusion was also prominent theme that arose, firstly just because the child has a disability and then secondly because alternative communication was seen as so different and “other” that it was further isolating. There was a definite call from families for practice shift that supported them more holistically out in their community. The Invisible String is a conceptual framework that proposes the union of decolonised practice concepts with the intersectionality of the families we work with. The image is of a patchwork quilt, families on one side, decolonial practise on the other with Speech-Language Therapists being the guiding hand to the needle of communication. The thread that binds it all is community. It is an offering of reuniting and remaking and bringing humanity and community to the forefront of practice.
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    The Classroom Communication Resource (CCR) intervention to change grade 7 peers' attitudes towards children who stutter (CWS) in the Western Cape: a randomised controlled trial
    (2018) Mallick, Rizwana; Kathard, Harsha; Thabane, Lehana
    Background: There is an established need to manage teasing and bullying of children who stutter (CWS) through changing the attitudes of their peers. The intervention, the Classroom Communication Resource (CCR), was implemented by teachers in classrooms. The primary objective of the main study was to determine the effectiveness of the CCR through a cluster Randomised Controlled Trial (RCT). The secondary objective of this study was to determine the treatment effect of the Stuttering Resource Outcomes Measure (SROM) within the subscales of Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine the primary objective between and across lower and higher school quintile clusters. Method: A cluster RCT was conducted. Participants in grade 7, aged 11 years and older, were randomly assigned to control and intervention groups using school and subgroup (quintile) clusters classifications. Following randomisation, stratification took place using a 1:1 allocation ratio. Participants viewed a video of a child who stuttered at baseline. Teachers administered the CCR (social story, role-play, discussion) in intervention groups only over a 60-90 minute session after they received an hour of training. Peer attitudes were measured at baseline and at 6 months post-intervention using the SROM in intervention and control groups. Results: A total of 10 schools were included whereby they were randomly allocated to control (k=5) and intervention groups (k=5). Within the schools, 454 participants were included with n =223 participants in the intervention and n= 231 in the control group. The study showed no statistically significant difference on the global SROM score (mean difference: -0.11 [95% confidence interval: -1.56, 1.34]; p = 0.88). Similarly, no significant differences were noted on SROM subscales: PSD (1.04 [-1.02,311]; p =0.32), SP (-0.45 [-1.22, 0.26]; p=0.21) and VI (0.05 [-1.01, 1.11]; 0.93), the secondary objective of this study. No significant subgroup effect on the global SROM score (lower vs higher quintile subgroups) [interaction p-value = 0.52] was observed during subgroup analysis. Results were however consistent with the hypothesis and quintile subgroups behaved similarly. Results were found clinically important when considering confidence intervals as well as the magnitude and direction of treatment effect. Conclusion: While the treatment effect showed no statistically significant differences on the global SROM and within the constructs of PSD, SP and VI, a clinically important result was noted when evaluating the meaningfulness of this study as well as its implications. Subgroup analysis showed that the quintiles behaved similarly, showing that the CCR was appropriate for schools within the lower and higher quintiles.
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    The Classroom Communication Resource (CCR) intervention to change peer’s attitudes towards children who stutter (CWS): study protocol for a randomised controlled trial
    (BioMed Central, 2018-01-17) Mallick, Rizwana; Kathard, Harsha; Thabane, Lehana; Pillay, Mershen
    Background: Children who stutter (CWS) are at a high-risk of being teased and bullied in primary school because of negative peer attitudes and perceptions towards stuttering. There is little evidence to determine if classroom-based interventions are effective in changing peer attitudes towards stuttering. The primary objective is to determine the effect of the Classroom Communication Resource (CCR) intervention versus usual practice, measured using the Stuttering Resource Outcomes Measure (SROM) 6-months post-intervention among grade 7 students. The secondary objective is to investigate attitude changes towards stuttering among grade participants on the SROM subscales. Methods: A cluster randomised controlled trial (RCT) will be conducted with schools as the unit of randomization. Schools will be stratified into quintile groups, and then randomized to receive the CCR intervention or usual practice. Quintile stratification will be conducted in accordance to the Western Cape Department of Education classification of schools according to geographical location, fee per school and allocation of resources and funding. Participants will include primary schools in the lower (second and third) and higher (fourth and fifth) quintiles and children aged 11 years or older in grade 7 will be included. The study will consist of the CCR intervention program or usual practice as a no-CCR control. The CCR is a classroom-based, teacher led intervention tool including a story, role-play and discussion. The grade 7 teachers allocated to the CCR intervention, will be trained and will administer the intervention. The analysis will follow intention-to-treat (ITT) principle and generalized estimating equations (GEE) to compare groups on the global SROM and its subscales to account for possible clustering within schools. The subgroup hypothesis will be tested by adding an interaction term of quintile group x intervention. Discussion: This study is designed to assess whether the CCR intervention versus usual practice in schools will lead to positive shift in attitudes about stuttering at 6-months post-intervention among grade 7 participants. Trial registration: The trial number is NCT03111524. It was registered with clinical trials.gov Protocol registration and results system (PRS) retrospectively on 9 March 2017.